The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Sunday, October 11, 2009

Socialized medicine in Australia: IS WESTMEAD HOSPITAL SHAPING UP TO BE ANOTHER KING/DREW?

The management at this big government hospital in Sydney seems to be nearly as hands-off it was at the disgraced and now-closed King/Drew hospital in Los Angeles. Two brand new reports below plus re-runs of two previous reports -- one from yesterday and another from March 8th:

Amazing bungle at Westmead leaves family seething

"He was in agony"... a feeding tube was wrongly inserted into the lungs of Francis Wilks-Tansley, 7. The bastards should be sued for millions for what they did to the boy

THE family of a boy who almost died after a ''breathtakingly basic'' hospital bungle nine months ago is still waiting for a written apology and a change in policy to prevent other children suffering the same fate. Francis Wilks-Tansley will be fed through a hole in his stomach for the rest of his life and is unable to breathe properly after a feeding tube was inserted into his lungs - and not detected for 36 hours.

During that time the seven-year-old, admitted to The Children's Hospital at Westmead for seizures, was given water and six medications through the tube, causing him to develop a life-threatening pneumothorax, where air gets trapped in the cavity around the lungs, and his right lung to collapse. One of the drugs, sodium valproate, causes severe chemical burns to lung tissue.

Up to six staff tended to Francis, who was born partially blind, deaf and with limited voluntary movement, over several shifts before the error was discovered, despite repeated calls from his mother, Sarah Wilks, that he was in respiratory distress. A chest drain was then inserted for 17 days to remove the fluid in his lungs. ''He was in agony, in extreme pain,'' she said yesterday.

One staff member, who did not want to be named, described the mistake as ''breathtakingly basic''. Staff must draw out some contents of feeding tubes as soon as they are inserted to test for the presence of stomach acid. A drop is placed on litmus paper, which turns a vivid pink if stomach acid is present. A chest X-ray can also be used to confirm the tube's placement, particularly in heavily sedated or unconscious children.

But Dr Wilks, who has a PhD in biology, said the lamp next to Francis's bed, used to check the colour on the litmus paper, was not working, making the room dim and difficult for staff to determine if the tube had touched stomach acid or lung secretions.

A case review carried out by the hospital found there had been three attempts to insert the tube, and its blood-stained contents had turned the litmus paper pink, leading staff to believe it had been placed correctly. But it also said difficult or repeated attempts should alert staff to the need for an X-ray to check position. After the incident, staff were sent a short email reminding them of the importance of correct tube placement.

''They almost killed my son and yet haven't changed their culture,'' Dr Wilks said. ''This is not an error made by one person. It was a group of people, which means there must be a systemic or cultural problem, and I want to make sure they can't do it again. I don't want them punished; I want them educated.''

Dr Wilks, who also has three teenagers, had bought a house in Hobart the day Francis was admitted to hospital and has been commuting twice a week to be with him. Yesterday the hospital offered to reimburse her air fares and promised a new policy would be in place by the end of the month.

But she is adamant the offers were made only because she contacted the NSW Health Minister, Carmel Tebbutt, last week. ''It's been an unconscionable length of time. An apology now is worse than no apology at all. There is nothing I can do to reverse the damage done to Francis but, at the very least, the hospital needs to ensure this doesn't happen to other children.''

A spokeswoman for the hospital yesterday said staff had verbally apologised to Francis's family. She said a statewide safety notice had been issued in February and a compulsory education program was being developed for all staff inserting feeding tubes, but it was not known when it would begin. ''The hospital sincerely regrets this incident and how it has affected Francis and his family. We are not denying we made a mistake, and we are sorry about it.''

FOUR patients a week admitted to Sydney's biggest hospital, Westmead, are being infected with potentially lethal golden staph and MRSA infections picked up while in the wards, hospital documents show. An investigation into where every one of the reported 2392 hospital-acquired infections, some known as "superbugs", occurred in 2008 in public hospitals showed Westmead topped the list, but other big hospitals including John Hunter, Liverpool, Blacktown and Royal North Shore were not far behind.

Experts believe the spread of infection is largely due to poor handwashing and other hygiene controls by nurses and doctors, The Daily Telegraph reports.

A report on golden staph and MRSA, published in the Medical Journal Of Australia this week, reported golden staph infections can prove fatal for up 21 per cent of those infected within a month. Survivors can face having treatment sometimes over years to beat the illness.

The documents show Westmead recorded 243 infections in 2008, including 201 cases of golden staph and its antibiotic-resistant variant, MRSA.

Newcastle's John Hunter Hospital came in second with 150 infection cases, including 126 golden staph and MRSA incidents. The third highest hospital was Liverpool, which had 144 cases including 100 golden staph and MRSA cases. Children's hospitals also reported potentially life-threatening infections.

The Children's Hospital at Westmead had 31 cases of hospital acquired infection while its sister facility at Randwick, Sydney Children's Hospital, recorded 28 cases.

NSW Health Deputy Director General Tim Smyth said the likelihood of getting an infection in a public hospital was very small. The Department reported in 2008 an average of just 3.8 cases of MRSA infection for every 1000 intensive care days in public hospitals and 2.5 infections for every 10,000 bed days for golden staph bloodstream infections.

A YOUNG mother at risk of sudden death from a brain cyst was left without a heart monitor for 20 hours before going into cardiac arrest at Westmead Hospital. Monitoring systems in the hospital's high-dependency unit were ''less than perfect'' when Rashpal Hayer died in July 2007, the NSW Coroner Mary Jerram said yesterday.

She was delivering findings after an inquest into Ms Hayer's death, which examined the failure to reattach the monitor and heard evidence of ''a 'culture' of silencing irritating alarms in that ward''.

Ms Hayer, 36, went to hospital with a severe headache. A CT scan revealed she had a colloid cyst, ''a very dangerous condition in which sudden death is known to be a possibility'', Ms Jerram said. A neurosurgeon instructed staff to monitor her closely, but a cardiac monitor was removed before a scan on July 2 and was not replaced when she returned to the ward. Ms Hayer was found in cardiac arrest at 6am on July 3. She never recovered brain function and died four days later.

Ms Jerram said nurses on the night shift and three doctors - including neurosurgical registrars - either failed to notice or saw no problem with the fact that she was without a cardiac monitor. Ms Hayer could possibly have been treated if a monitor had been fitted and sounded when she went into arrest, she said.

The inquest also heard that a finger probe monitoring Ms Hayer's pulse and oxygen levels had detached half an hour before her cardiac arrest. It should have sounded warnings.

Ms Jerram said it was possible the alarm connection to the nurses' station was not working, or that ''the alarms were deliberately silenced at some stage … not necessarily from any malice''. She accepted evidence from a nurse that the ward had a culture of ''silencing irritating alarms''.

Ms Jerram made no formal recommendations, noting that the hospital conducted three investigations into the death and had policies to remedy some of the problems highlighted.

Bed numbers have been slashed this week at Sydney's biggest hospital, in a round of ward closures aimed at reining in a $70 million blow-out in the region's health spending. Ten of 16 operating suites have been closed and elective surgery has been cancelled, with staff forced to take leave, sources said. Forty-three cardiology and heart surgery beds have shut since late last year, said medical and nursing staff, culminating last week in the closure without notice of the heart surgery ward - which staff found empty and locked when they arrived for work.

The unprecedented axing of about 70 beds comes after the Herald revealed in late January that Sydney West Area Health Service, which oversees Westmead, owed $26 million to creditors - more than any other region and almost a quarter of NSW Health's outstanding debt to suppliers at that time.

Neurosurgery and general surgery beds have also closed, said the sources, while casual nursing shifts have been curtailed across the entire hospital, as displaced permanent staff are redeployed into vacancies on the roster. The closures represent about 9 per cent of Westmead's total capacity, and are the biggest round of cuts at a single hospital to strike the beleaguered state health system. The chairman of the hospital's Medical Staff Council, Andrew Pesce, said the closures were by far the most severe the flagship teaching hospital had seen. "It's a quantum leap [compared with] the modest bed closures usually built around [public] holidays," Dr Pesce said.

Coming a month before Easter and without any promise that beds would reopen or surgery resume, the closures were the equivalent of an extra Christmas closedown, said Dr Pesce - referring to the practice of selectively suspending services during the holiday period to save money. "If things continue the way they are going, the morale of the place will become so low that doctors and nurses will start leaving," he said. Hospital managers were not solely to blame because NSW Health gave them "unrealistic budgets".

Public hospitals had traditionally been insulated from state spending cuts, Dr Pesce said, but NSW's wider financial crisis meant they were no longer receiving favourable treatment. Health accounts for about one-third of the state's spending, and had blown out by about $300 million at the time of November's mini-budget. Area health services were ordered to save $943 million over four years.

A spokesman for the Health Minister, John Della Bosca, declined to address the Herald's specific questions about closures, offering instead in a written statement: "There have been adjustments to bed platforms and relocations of some services within Westmead's overall funding base . Westmead has further capacity to improve bed utilisation and this is a priority for management attention in the relevant services as part of the operational strategy." He also did not answer a question about the number of patients whose elective operations were cancelled, instead insisting elective surgery was still available but saying the hospital was "under resource pressure and needs to ensure that its priorities are met but not exceeded and that all opportunities to ensure it operates efficiently are explored".

The president of the NSW branch of the Australian Medical Association, Brian Morton, said he understood patients would be moved to general wards under the care of "staff who don't have the same skills". Patients would be at risk if already overcrowded hospitals were further stressed. .. That's when mistakes happen."

The Opposition's health spokeswoman, Jillian Skinner, said the closures would endanger patients. "The evidence is quite clear that delayed treatment makes conditions worse and makes the hospital stay longer - and therefore more expensive."

1. Was written by a committee whose head says he doesn't understand it

2. Passed by a Congress that hasn't read it but exempts themselves from it

3. Signed by a president that also hasn't read it and who smokes

4. With funding administered by a treasury chief who didn't pay his taxes

5. Overseen by a surgeon general who is obese and

6. Financed by a country that's nearly already broke

What could possibly go wrong?

Does high-tech medicine mean higher health care costs?

A new report finds that medical innovation boosts life expectancy, but doesn't cost more

"About half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology," declared a Congressional Budget Office (CBO) report last year. "Health care economists attribute about 50 percent of the annual increase of health costs to new technologies or to the intensified use of old ones," writes bioethicist Daniel Callahan in his new book, Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Conventional wisdom holds that the nation is facing a massive health care bill thanks to our use (and potential overuse) of pricey new treatments and technology.

But is it true that expensive high-tech medicine is to blame for rising health care costs? Callahan complains that "American health care is radically American: individualistic, scientifically ambitious, market intoxicated, suspicious of government, and profit-driven." And he's right about America's high-tech vitality: The U.S. health care system does develop and deploy medical innovations much faster than other rich countries. New pharmaceutical products generally launch here two years earlier than elsewhere, according to a December 2008 report from the business consultancy McKinsey (which also blamed high-tech medicine for escalating costs). Plus, American physicians are "much quicker to adopt new surgical techniques and advances in anesthesia." The top five U.S. hospitals alone conduct many more clinical trials than any other single other developed country.

But in June, Columbia University economist Frank Lichtenberg published a new study that suggests advanced medical technologies are not contributing all that much toward rising U.S. health care expenditures. Lichtenberg begins by looking at how the rate of increase in longevity has varied among U.S. states between 1991 and 2004. He investigates how such factors as the quality of medical care, behavioral risks (obesity, smoking, and AIDS incidence), and education, income, and health insurance coverage affect life expectancy. To measure differences in the quality of medical care, Lichtenberg examines how quickly each state took up advanced medical diagnostics and new drugs. He also calculates what fraction of physicians in a state were trained at top-ranked medical schools.

Lichtenberg's key finding is that life expectancy increased faster in states that more rapidly adopted advanced diagnostic imaging techniques, newer drugs, and attracted an increasing proportion of doctors from top medical schools.

The good news is that between 1991 and 2004 average life expectancy at birth in the U.S. increased 2.37 years. During that time Lichtenberg finds that nationwide the use of advanced imaging procedures nearly doubled from about 10 percent to nearly 20 percent. Lichtenberg calculates that the deployment of advanced diagnostic imaging techniques (e.g., CT scans, MRIs) is responsible for boosting average U.S. life expectancy by 0.62-0.71 years during this period. In addition, he estimates that the adoption of newer drugs increased average U.S. life expectancy by about 1.5 years. On the other hand, the fraction of physicians being trained at top medical schools has declined, which Lichtenberg reckons has reduced overall life expectancy by 0.28-0.47 years.

Interestingly, Lichtenberg found that "growth in life expectancy was uncorrelated across states with health insurance coverage and education, and inversely correlated with per capita income growth." The last finding is a bit puzzling. Lichtenberg calculates that the average 20 percent increase in real per capita income resulted in lowering average life expectancy by 0.34-0.42 years and finds that states with high income growth had smaller longevity increases. He does not speculate on why higher incomes lowered life expectancy but perhaps richer people engaged in riskier behaviors that are unaccounted for in Lichtenberg's model. For example, binge drinking in older men correlates with higher incomes.

It's not too surprising that high-tech medicine and better physician training boost life expectancy, but what about their costs? To answer that question, Lichtenberg looked at per capita medical spending by state. The top six states used advanced imaging diagnostics roughly 30 percent more often than the bottom six, for instance, making them ripe for comparison. He found that the states with larger increases in high-tech diagnostic procedures, newer drugs, and higher quality physicians did not have larger increases in per capita medical spending.

"The absence of a correlation across states between medical innovation and expenditure growth is inconsistent with the view that advances in medical technology have contributed to rising overall US health care spending," he concludes. Lichtenberg further speculates that states that have more quickly adopted high-tech procedures have not seen their health care expenses increase because "while newer diagnostic procedures and drugs are more expensive than their older counterparts, they may reduce the need for costly additional medical treatment." In other words, high-tech medicine may initially cost more, but it reduces spending in the long run, while increasing the life expectancies of patients.

Cost cop Callahan has a solution to the alleged problem of escalating technological costs: Adopt the methods used by European universal government-funded health care systems:"They use—among other tools—price controls, negotiated physician fees, hospital budgets with limits on expenditures, and stringent policies on the adoption and diffusion of new technologies." In other words, stifle innovation.

"Cutting the use of technology will seem wrong—even immoral—to many," Callahan admits. Well, yes. And if Lichtenberg is right, slowing technological progress in medicine wouldn't save money, but it definitely would kill more people.

A Senate plan to expand health insurance coverage to an additional 29 million people would not come cheap, with taxpayers, businesses and the elderly poised to foot most of the bill.

The legislation by Senate Finance Committee Chairman Max Baucus, D-Mont., which is scheduled for a committee vote Tuesday, would cost $829 billion over the next 10 years. Yet in spite of that staggering price tag, it would slash the federal deficit by $81 billion, according to an analysis by the independent Congressional Budget Office.

That's $910 billion the government would have to raise over the next decade. The bill calls for getting half of that money through various taxes and the other half by slashing expenses tied to Medicare, the program that provides health care for Americans 65 and older.

The Baucus bill would raise $201 billion over 10 years through an excise tax on top-tier insurance policies. Beginning in 2013, insurance companies would incur a 40 percent tax on any policy that exceeded $8,000 for individuals and $21,000 for families.

Government coffers would get an additional $23 billion over the next decade from employers with more than 50 workers that don't offer health insurance. These companies would pay a fine for every employee who qualified for a federal health care subsidy. And anyone who does not have some kind of health insurance would pay a fee, up to $950 for an individual and up to $3,800 for a family, which the CBO estimates would add up to $4 billion in revenues in the coming decade.

The government would also levy more payroll taxes. Included in a footnote in the CBO report is the revelation that the government expects to raise an extra $83 billion in payroll taxes in the next 10 years thanks to the higher taxable wages they predict employers will offer in place of non-taxable health care benefits.

Added together, these new taxes total $311 billion, a number that critics say is far too high. "They tax us to the point that they reduce the deficit," said Michael Tanner, a health care policy expert at the Cato Institute, a libertarian think tank. "In essence, the deficit savings you have are simply because of the tax increases."

Even after taxes, the government would still need an additional $599 billion to achieve the cost-bending estimate provided by the CBO. The Baucus bill calls for getting the bulk of that money from cuts to Medicare spending. According to the CBO, the Baucus bill would trim at least $426 billion from Medicare, much of it from slashing the popular Medicare Advantage plan, which offers more benefits than traditional Medicare for seniors willing to pay higher premiums. Reimbursement rates for Medicare Advantage plans would be reduced by $117 billion over 10 years under the Baucus bill.

Karen Davenport, director of health care policy at the Center for American Progress, a liberal public policy research and advocacy group, disputed a claim by critics that the funding cuts would amount to a reduction in benefits for seniors.

"What it's doing is trying to push change in the health care system so they are using Medicare as a lever for hospitals and doctors practices to help change the trajectory of health care costs," she said.

The Center for Freedom and Prosperity Foundation today released a study examining how protectionist policies by states, combined with expensive mandates that benefit interest groups such as chiropractors, make it hard for families to afford health insurance. The study, entitled "The Health Care Choice Act: Restoring Competition in the Individual Insurance Market," explains that insurance will be more affordable if the Constitution's promise of unfettered interstate commerce is realized, thus enabling families to purchase insurance plans issued in other states. Authored by Dr. Sven Larson, the study specifically recommends Congressman John Shadegg's Health Care Choice Act (H.R. 3217), as a step forward.

"Dr. Larson explains how mandates drive up the cost of health care by denying consumers the freedom to buy inexpensive no-frills coverage. And since consumers are not allowed to purchase plans issued in other states, this creates an oligopoly that leads to even higher prices," said Andrew Quinlan, President of the CF&P Foundation.

"The Constitution's interstate commerce clause is supposed to prevent protectionism among states," added Dan Mitchell, Senior Fellow at the Cato Institute and Chairman of CF&P's Board, who also noted that, "Dr. Larson's study is another example of how competition between governments promotes better policy and protects individual rights."

America's health care system has state-of-the-art technology, highly skilled medical professionals and access to cutting edge medical research. However, government restrictions are artificially boosting costs and making it more difficult for families to get health insurance. More specifically, regulatory intervention by state governments is a significant problem, particularly protectionist barriers preventing consumers from buying insurance policies issued in other states. Combined with expensive mandates that states impose on health plans – for everything from chiropractors to breast reduction, the results are less competition and higher premiums. Congressman John Shadegg (R-AZ) has introduced the Health Care Choice Act (H.R. 3217) to restore unfettered interstate commerce and let consumers shop for health insurance plans in a national market. According to one estimate, freedom to purchase insurance policies issued in other states could save some families as much as 30 percent on their health policies. Unleashing the Constitution's promise of unfettered interstate commerce is the most effective way of breaking up the inefficient oligopolies created by state politicians.

1 comment:

Anonymous
said...

"...high-tech medicine may initially cost more, but it reduces spending in the long run, while increasing the life expectancies of patients."

This puts a real dent in my theory that health care is a pure luxury good due to the requirement of a fully skilled professional analyzing each and every output unit (patient outcome), very much unlike other industries. I assumed that all the ultra expensive diagnostic machines were changing too fast to ever pay for themselves in savings, which is evidently incorrect.

It leaves real hope that technology *can* eventually allow mere nurses to take over the role of doctors for much of one's health care. Computerized diagnostics would be the real game changer, freeing up doctors to concentrate only on immediate fast-changing emergency situations.

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

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